|LETTER TO EDITOR
|Year : 2017 | Volume
| Issue : 2 | Page : 82-83
Vidyadhar R Sardesai1, Sonam M Vimadalal2, Madhulika A Mhatre3
1 Department of Dermatology, Venereology and Leprosy, Bharati Vidyapeeth University Medical College, Pune, Maharashtra, India
2 Associate Dermatologist, Skin Secrets, Dermatology and Aesthetics, Mumbai, Maharashtra, India
3 Consultant Dermatologist, Wockhardt Hospitals, Mumbai, Maharashtra, India
|Date of Web Publication||28-Jul-2017|
Vidyadhar R Sardesai
102, Alliance Nakshatra, 48 Tulshibagwale Colony, Sahakarnagar No. 2, Pune - 411 009, Maharashtra
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Sardesai VR, Vimadalal SM, Mhatre MA. Dermatosis neglecta. Clin Dermatol Rev 2017;1:82-3
Dermatosis neglecta is a condition that arises from inadequate frictional cleansing and presents both diagnostic and therapeutic challenges to the treating clinician. It is an often misdiagnosed and under diagnosed condition.
We report a case of a 26-year-old female, who presented with multiple hyper pigmented, velvety appearing plaques over the lower abdomen, around a painful scar with areas of normal skin in between [Figure 1]. On enquiry, she gave a history of a lower segment cesarean section 1 month back. There was no history of usage of any topical medication before the appearance of lesions. No history of pruritus associated with the lesions. There were no skin lesions anywhere else on the body and no systemic symptoms were present. The lesion was cleansed with a normal saline swab, after which normal skin was seen underneath [Figure 2]. Dirt and debris was collected on the swab [Figure 3]. The patient later gave a history of avoiding cleansing in the scar area due to fear of pain and dislodgment of stitches.
Dermatosis neglecta is a term coined for cases of unwashed dermatosis by Poskitt et al. in 1995. There is a progressive accumulation of sebum, sweat, keratin, dirt and debris, resulting in the formation of a hyper pigmented or a verrucous plaque. There is usually negligence of cleanliness and hygiene of the affected area which is often denied by the patient. Prompt suspicion of this condition obviates the need of any invasive procedures for diagnosis like biopsy.
Another type of similar dermatosis known as terra firma-forme dermatosis, differs from dermatosis neglecta, in that, the patient cleans the lesion regularly but no resolution of lesion occurs unless swabbed with alcohol. Other differentials to be kept in mind are acanthosis nigricans, linea nigra, verrucous naevi, confluent, and reticulated papillomatosis of Gougerot and Carteaud, hyperkeratotic malassezia dermatosis and post inflammatory hyper pigmentation. It should also be differentiated from dermatitis artefacta, where the lesions are created by the patient as opposed to dermatosis neglecta, where the lesions develop due to negligence.
Dermatosis neglecta is an under-reported, asymptomatic, but esthetically bothersome dermatosis. Clinicians need to be aware of this condition that can be clinically diagnosed and effectively and inexpensively treated.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Lucas JL, Brodell RT, Feldman SR. Dermatosis neglecta: A series of case reports and review of other dirty-appearing dermatoses. Dermatol Online J 2006;12:5.
Choudhary SV, Bisati S, Koley S. Dermatitis neglecta. Indian J Dermatol Venereol Leprol 2011;77:62-3.
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Poskitt L, Wayte J, Wojnarowska F, Wilkinson JD. 'Dermatitis neglecta': Unwashed dermatosis. Br J Dermatol 1995;132:827-9.
[Figure 1], [Figure 2], [Figure 3]